SW5210403_Supplemental Info Review_20210429

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/29/2021 3:47:48 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 4/30/2021 7:27:30 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 4/29/2021 3:48 PM

Submittal Dated: 4/29/2021
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Existing Project Information:
Rease suDDly the Derrrit nunber for this Drolect.
D# * Perrrit Nurrber
SW5210403
Exarrples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Princeville Farmer's Market
County: Edgecombe
Name: William A. Larsen, P.E.
Vft is subrritting the inforrretion?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
210421—Princeville 2849-J Stormwater Application
2.67MB
(1).pdf
Plans TheWootenCo 2849J 20210331.pdf 53.27MB
Only pdf files are accepted.
Please alert us to any confidential information contained in the uploaded documents.
Uploads contain r NO
Confidential r YES
Information * NOTE The following inforrretion cannot be claimed as confidential: the narre and address of any perrrit applicant or
pernittee, perrrit applications, perrrits, effluent data, information required by WCM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Princeville Farmer's Market Stormwater Permit Application and Plans
* W By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of the
NC General Statutes (the "Uniform Electronic Transactions Act")
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written

signature; AND
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* William A. Larsen, P.E.
Signature:
Date Submitted: 04/29/2021

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW5210403
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 04/30/2021